Provider Demographics
NPI:1114957016
Name:HOBOKEN RADIOLOGY, LLC
Entity Type:Organization
Organization Name:HOBOKEN RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-222-2500
Mailing Address - Street 1:79 HUDSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5638
Mailing Address - Country:US
Mailing Address - Phone:201-222-2500
Mailing Address - Fax:201-469-0555
Practice Address - Street 1:79 HUDSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5638
Practice Address - Country:US
Practice Address - Phone:201-222-2500
Practice Address - Fax:201-469-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23188261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0043001Medicaid
NH2280953000OtherAMERIHEALTH HMO
NJA3197301OtherOXFORD
NJ7013612OtherAETNA GOLDEN CHOICE/MEDIC
NJ036754OtherCIGNA PPO
NJ1600372OtherAMERIHEALTH PPO
NJ3606490OtherAETNA HMO
NJ0043001Medicaid